Over the past 25 years a serious health crisis has occurred in our country, and it has not only caused devastating damage to individuals and families, but it is preventable.Billions of dollars are spent annually in health care costs by those who are affected, while others are likewise spending billions of dollars to treat and prevent the condition. The problem is obesity and left untreated can become morbid obesity in which a person is at least one hundred pounds over their ideal weight. As a nation and a culture we are simply eating ourselves to death.
During my years as a general surgeon I treated my share of patients who were morbidly obese. I confess I dreaded seeing such a patient referred to me for a surgical procedure, because the complication rates were so high and the mortality rates were also increased. I had a family practitioner who referred many patients to me for care, and he would frequently say something like this, “I have a lady who needs her gall bladder removed because of stones, and she is also suffering from acute biscuit poisoning!” It would have been funny were the patients not so prone to poor healing and infections. On one particular weekend I remember doing emergency gall bladder surgery on three women whose combined weights were eleven hundred pounds. Fortunately for my surgical team we were able to do the laparoscopic procedure on each of them, and this was physically much easier than the old-fashioned open procedure. And fortunately for the patients each of them healed with no complications.
When I transitioned into wound care for the last twelve years of my practice life I also treated many extremely obese patients. One of the many problems of morbid obesity is chronically swollen and edematous lower extremities. This can lead to open wounds of the lower legs, particular in a diabetic patient, and these wounds are hard to heal and prone to enlarge and become infected.
When I practiced at Washington Regional Medical Center in Fayetteville, Arkansas, one of my referring physicians was Dr. Tim Cogburn (fictitious name), an internist. His medical office was in the hospital building one floor above the Wound Care Clinic. Occasionally he would come to the clinic for a brief visit, and we would have a cup of coffee together. We became good friends, and he and his wife Darlene (fictitious) even joined our Sunday school class at University Baptist Church.
On one particular visit we were discussing a patient he had referred for treatment of a poorly healing leg ulcer. She was extremely obese, and the wound was requiring an unusually long time to heal. Tim said, “I send you quite a few of my patients with chronic wounds, and all of them are overweight. I understand all of the physical and emotional things an overweight person deals with because of my own experience. I understand the stress in an obese person whose only thoughts are about food, and the intense craving such an individual has for carbohydrates.” I didn’t comment on his remarks because Tim weighed in excess of three hundred pounds. Then he made a shocking statement when he said, “I’m just a shadow of my former self. A few years ago I weighed in excess of six hundred pounds!” He continued, “I knew as a physician I would not live much longer with that kind of weight so I had a stomach stapling procedure, and as a result lost over three hundred pounds.”
We had a brief conversation about the benefits of surgical procedures for extreme obesity, and I asked him, “How many calories a day does a person consume to maintain a weight of over six hundred pounds? Over ten thousand calories?” Tim said, “Probably so.” He continued; “Let me tell you a couple of things I did to satisfy my intense hunger pain.
Our home was approximately a twenty to twenty-five minute drive from my medical office. Within a block of our home was a doughnut shop which made the most delicious doughnuts I ever ate. I would stop there every morning and buy two dozen doughnuts, and I would eat every one of them while making the drive to the office.” “You ate two dozen doughnuts every day?” I asked. “Yes sir, and then would have a snack of something sweet before lunch,” he said. I quickly calculated at two hundred calories per doughnut, he was consuming forty eight hundred calories daily in doughnuts alone.
“Another story about my food cravings is rather humorous,” he said. “Darlene and I love barbecue sandwiches, and there was a well-known barbecue cafe in town. She called one day and asked if I would stop by the cafe and bring sandwiches home for dinner. I ordered one jumbo-sized for her and four jumbo’s for me and started home. The odor of the freshly made sandwiches was too much for me to resist, and before I made it home I had eaten all five of the jumbo sandwiches. Darlene was so mad at me, and after an argument I agreed the next time I brought sandwiches home I would place them in the trunk of the car to prevent me from getting to them. That’s part of the harmful psyche of a morbidly obese individual.”
I confess I love to eat, and many of the foods I enjoy are not healthy when eaten as part of a regular diet. Fried catfish, chicken fried steak, hamburgers, French fried potatoes, cinnamon rolls, and almost any dessert dish are among my favorites. I have learned over the past few years since my intense exercise routines have diminished, eating all the foods I enjoy are a sure path to excess weight gain. Likewise when I restrict the intake of such high carbs I will lose weight. A simple formula for weight loss which I advised my surgical patients who asked is to increase your exercise program and decrease your caloric intake. It is no magic formula, but it works. Losing extra pounds and coming as close to one’s ideal weight will sure make your surgeon happy, and it might just prolong your life!